<form action="?register/1" method="post" onsubmit="return check_form(this);">
<table border="0" cellpadding="0" cellspacing="3" class="text">			  
	<tr>
		<td colspan="2" height="40" valign="bottom"><strong>Customer Type </strong></td>
	</tr>
	<tr>
		<td  colspan="2">
			<input type="radio" value="retail" {if($_POST['type'] == 'retail' || !$_POST['type'])}checked="checked"{/if}  name="type" id="retail" />
			<label for="retail">Retail&nbsp;&nbsp;</label>
			<input type="radio" value="wholesale" {if($_POST['type'] == 'wholesale')}checked="checked"{/if}  name="type" id="wholesale" />
			<label for="wholesale">Wholesale</label>
		</td>
	</tr>

	<tr>
		<td colspan="2" height="40" valign="bottom"><strong>Customer Information Detail </strong></td>
	</tr>
	<tr>
		<td   >&nbsp;First Name:</td>
		<td  >
			<input name="fname" required="true"  type="text" class="text" id="fname"   value="" />*
		</td>
	</tr>
	<tr>
		<td  >&nbsp;Last Name:</td>
		<td >
			<input name="lname"  required="true"  type="text" class="text"  id="lname"   value=""/>* 
		</td>
	</tr>
	<tr>
		<td  >&nbsp;Email Address:</td>
		<td >
			<input name="email"  required="true"  type="text" class="text"  id="email"    value="" />*
		</td>
	</tr>
	<tr>
		<td colspan="2" height="40" valign="bottom"><strong>Billing & Shipping Information</strong></td>
	</tr>
	<tr>
        <td   >&nbsp;Street:</td>
		<td  >
			<input name="street"  required="true"  type="text" class="text"  id="street" / value="">
		* (include apt #, if you have) 
		</td>
	</tr>
	<tr>
		<td  >&nbsp;City:</td>
		<td >
			<input name="city"  required="true"  type="text" class="text"  id="city" / value="">*
		</td>
	</tr>
	<tr>
		<td  >&nbsp;State:</td>
		<td >
			<select name="states"  class="text" id="states">
                                  <option value="AL" >Alabama</option>

                                  <option value="AK" >Alaska</option>
                                  <option value="AZ" >Arizona</option>
                                  <option value="AR">Arkansas</option>
                                  <option value="CA">California</option>
                                  <option value="CDA">Canada</option>
                                  <option value="CO">Colorado</option>

                                  <option value="CT">Connecticut</option>
                                  <option value="DE">Delaware</option>
                                  <option value="DC">District of Columbia</option>
                                  <option value="FL">Florida</option>
                                  <option value="GA">Georgia</option>
                                  <option value="HI">Hawaii</option>

                                  <option value="ID">Idaho</option>
                                  <option value="IL">Illinois</option>
                                  <option value="IN">Indiana</option>
                                  <option value="IA">Iowa</option>
                                  <option value="KS">Kansas</option>
                                  <option value="KY">Kentucky</option>

                                  <option value="LA">Louisiana</option>
                                  <option value="ME">Maine</option>
                                  <option value="MD">Maryland</option>
                                  <option value="MA">Massachusetts</option>
                                  <option value="MI">Michigan</option>
                                  <option value="MN">Minnesota</option>                                  <option value="MS">Mississippi</option>
                                  <option value="MO">Missouri</option>
                                  <option value="MT">Montana</option>
                                  <option value="NE">Nebraska</option>
                                  <option value="NV">Nevada</option>
                                  <option value="NH">New Hampshire</option>

                                  <option value="NJ">New Jersey</option>
                                  <option value="NM">New Mexico</option>
                                  <option value="NY">New York</option>
                                  <option value="NC">North Carolina</option>
                                  <option value="ND">North Dakota</option>
                                  <option value="OH">Ohio</option>

                                  <option value="OK">Oklahoma</option>
                                  <option value="OR">Oregon</option>
                                  <option value="PA">Pennsylvania</option>
								  <option value="PR" >Puerto Rico</option>
                                  <option value="RI">Rhode Island</option>
                                  <option value="SC">South Carolina</option>

                                  <option value="SD">South Dakota</option>
                                  <option value="TN">Tennessee</option>
                                  <option value="TX">Texas</option>
                                  <option value="UT">Utah</option>
                                  <option value="VT">Vermont</option>
                                  <option value="VA">Virginia</option>

                                  <option value="WA">Washington</option>
                                  <option value="WV">West Virginia</option>
                                  <option value="WI">Wisconsin</option>
                                  <option value="WY">Wyoming</option>
                                </select>            * 
		</td>
	</tr>
	<tr>
		<td  >&nbsp;ZipCode: </td>
		<td >
			<input name="zip"  required="true"  type="text" class="text"  id="zip" maxlength="5"  value=""/>*
		</td>
	</tr>
	<tr>
        <td  >&nbsp;Country:</td>
		<td >USA</td>
	</tr>
	<tr>
		<td  colspan="2" height="40" valign="bottom" ><strong>Contact Information</strong></td>
	</tr>
	<tr>
		<td   >&nbsp;Phone#:</td>
		<td  >
		<input name="phone"  required="true"  type="text" class="text"  id="phone"  value=""/>
		*(eg. xxx-xxx-xxxx)</td>
	</tr>
	<tr>
		<td  >&nbsp;Fax#:</td>
		<td >
		<input name="fax"   type="text" class="text"  id="fax"  value=""/>
		</td>
	</tr>
	<tr>
	<td colspan="2" height="40" valign="bottom"><strong>Customer Password</strong></td>
	</tr>
	<tr>
		<td   >&nbsp;Password:</td>
		<td  ><input name="password"  required="true" type="password" class="text" id="password"   maxlength="10" />
		*
		</td>
	</tr>
	<tr>
		<td  >&nbsp;Re-enter &nbsp;Password:</td>
		<td >
		 <input name="password2"  required="true" type="password" class="text" id="password2"   maxlength="10"/>
		*</td>
	</tr>
	<tr>
		<td  colspan="2" >&nbsp;<input type="submit" value="Submit" /></td>
	</tr>
</table>
</form>
<script>
<?php
$data = $_POST;
if ($data)
{
	echo 'var data='.json_encode($data).';';
	?>
	for(var key in data)
	{
		$('#'+key).val(data[key]);
	}
	<?php
}
?>

function check_form(f)
{
	var inputs = $(f).find('[required]');
	for(var i = 0; i<inputs.length; i++)
	{
		if (inputs.eq(i).val() == "")
		{
			inputs.get(i).focus();
			return false;
		}
	}
	
	if ($('#password').val() != '' && $('#password').val() != $('#password2').val())
	{
		alert('Please enter the same password twice!');
		return false;
	}
	
	if (!$('#email').val().match(/\@/))
	{
		alert('Invalid email address!');
		return false;
	}
	
	
	return true;
}
</script>